ASE STUDENT BULLYING, HARASSMENT, or INTIMIDATION REPORTING FORM
Bullying and harassment are serious and will not be tolerated. This is a form to report alleged harassment or bullying that occurred on school property; at a school sponsored activity or event off school campus; on a school bus; or on the way to and/or from school, in the current school year. If you are a student victim or a friend of student who is getting harassed or bullied and wish to report and incident of alleged harassment or bullying, complete this form and submit it to the Dean of Discipline, or the front office.

BULLYING is considered, but not limited to, any of the following: verbal or physical harassment or threat there of, taunting, hazing, intimidating or any other action whereby one or more individuals deliberately single out another student for cruel, mean and/or humiliating treatment.

If this is an URGENT bullying matter or an EMERGENCY, please speak directly to an administrator.

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Date and Time of Incident
Please report the incident date
MM
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DD
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YYYY
Time
:
Student Reporting the Incident
Was an adult near at the time?
If so who was the person?
Where did the incident happen? (choose all that apply)
Clear selection
Describe the incident(s), including what the alleged offender(s) said or did
Submit
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